Provider Demographics
NPI:1952303349
Name:GOHAR, KAYHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAYHAN
Middle Name:
Last Name:GOHAR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-2305
Mailing Address - Country:US
Mailing Address - Phone:310-677-4767
Mailing Address - Fax:310-677-7508
Practice Address - Street 1:257 S MARKET ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-2305
Practice Address - Country:US
Practice Address - Phone:310-677-4767
Practice Address - Fax:310-677-7508
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist